CT Center for Patient Safety Newsletter

January 2016

In This Issue

Important Questions to ask before you go to the hospital

Rate of decline in Hospital-Acquired Conditions leveled in 2014

Twelve Questions

18 Connecticut Hospitals Penalized

January Health Hint

Young Children are being given antipsychotics

What are Patient Advisory Councils?

Important Questions to ask before you go to the hospital

If you are thinking about scheduling surgery, there are a number of things that you can ask and do ahead of time to prepare for the experience. According to Scott Ellner of St. Francis Hospital, you should ask the following questions of your surgeon:

How long will I be in the hospital?

What is going to be done?

Who is on the team that is treating me? (I would like to add, Will my surgeon be present the entire time.)

What are the common complications, and how might they impact me?

What support services are available when I leave the hospital? What is the likelihood that I will need them?

What is my long-term recovery going to be like?

Patient advocates Helen Haskell and Lisa Freeman add the following questions and suggestions:

What are the short- and long-term risks and benefits?

Are there any alternative treatments?

What will happen if I don't do anything?

Try to learn who is who and ask people who enter your room to identify themselves by name and by their position.

Use bleach wipes to clean surfaces in order to avoid infections.

Bring a complete medication list

Bring a medical information sheet with relevant information: name, address, contact information, if an interpreter is needed, who their doctors are, and any past or current medications, conditions, surgeries, allergies or adverse reactions. This can be especially useful to have on hand in an emergency.

Try to record your discharge instructions, or any conversations that you may want to listen to when you get home.

Keep a journal of your hospital stay.

And always remember, if you see something, say something. If you have a question, ask it.

For additional information, read Nine things all hospital patients should know in the CT Mirror.

Rate of decline in Hospital-Acquired Conditions leveled in 2014

Since 2011, the rate of avoidable hospital acquired conditions decreased annually from its 2010 baseline. However, between 2013 and 2014 the rate held at 17%. Although this represents a clear reduction in avoidable hospital acquired conditions, according to Kaiser Health News, it means that there have been "at least 4 million infections and other potentially avoidable injuries in hospitals last year." The most common complications according to the AHRQ report were bedsores, falls, and bad reactions to drugs. The good news from this report is that there were fewer incidents of harm resulting in an estimated 87,000 fewer deaths each year. That, however, is in relation to the estimated 400,000 deaths per year from medical harm or only a 22% decrease. There must still be more work done on the part of hospitals to bring that number nearer to zero.

Twelve Questions

The NYTimes.com has a wonderful section, edited by Tara-Parker Pope, called well.blogs.nytimes.com. A regular feature of this blog is the weekly Ask Well post. Recently, they published a year-end post titled: Most Popular Health Questions You Asked This Year. The questions covered a variety of different topics including The Best Exercise to Reduce Blood Pressure, Catching Up on Lost Sleep and Floss or Brush First? just to mention a few. Do check it out!

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Dear Members,

I want to wish everyone a happy and healthy New Year from all of us at CTCPS.

This is a time of year when many of us pause, reflect and think about ways that we can better our lives and the lives of those around us. At the Connecticut Center for Patient Safety, our mission is to work to promote patient safety, improve the quality of health care and protect the rights of patients. We are hoping for the day when avoidable medical harm is reduced to zero and all people receive the highest quality of health care. However, there is still a lot of work to be done to achieve this and in 2016, as in every year, we will continue to focus our efforts on this ultimate goal.

I recently heard from a member asking about a surprise bill for a hospital facility fee that she received after seeing a physician in their private office. This is a charge that more and more patients began to see as hospitals bought up private practices and were now able to add on their own charge for overhead. It seems apropos at this time to review a significant event from last year. On a positive note, the Connecticut Legislature passed a bipartisan healthcare bill that addressed surprise charges and other patient concerns and brought about greater transparency in health care for CT residents. The highlights of the bill, many of which are now in effect, can be viewed in this CT Mirror article: Cheat sheet: What's in the big health care bill. Residents will now see disclosure of facility fees and hospital affiliations. They will be able to get certain "cost of medical care, including their estimated out-of-pocket costs, as well as data on quality measures and patient satisfaction, which providers are in the network, accepting new patients, and the language providers speak." The development of a statewide health information exchange which will allow more universal access to patient health records is in process. We believe that this will make healthcare safer and more efficient for many residents of Connecticut.

Lisa Freeman

18 Connecticut Hospitals Penalized by CMS For High Infection Rates

MS recently announced that nationwide, 23 percent of all eligible hospitals would be penalized for patient safety lapses between 2012 and 2014 as part of the Hospital-Acquired Condition Reduction Program. The 18 hospitals that will be penalized in Connecticut make up close to 60 percent of Connecticut's hospitals which is above the national average of 23%.

As part of the healthcare overhaul, patient safety sanctions are one of the programs that Medicare uses financial motivation to penalize hospitals that they feel are underperforming. In this program, only the bottom 25% of hospitals nationally were penalized. The biggest criticism of these penalty programs is that hospitals are penalized because they fall in the bottom quartile regardless of whether or not they are making improvements. At CTCPS, we feel that the success of lowering complication rates and raising awareness of the issues around avoidable medical harm justifies these programs. We must not forget that these statistics are much more than just numbers - they are people - our mothers, fathers and other family members. What is being measured is avoidable harm and no avoidable harm is acceptable. More can be read in the C-Hit article from Dec. 20^th.

Other programs where hospitals are penalized address high rates of readmissions and poor performance on certain clinical and mortality-rate measures. In 2015-16, all but one of Connecticut's acute-care hospitals will lose some Medicare reimbursement as a penalty for high readmissions of discharged patients, new federal data show. According to an analysis of the data, the seven CT hospitals being penalized more than 1% are Milford Hospital (1.70 percent); Middlesex, in Middletown (1.38); Johnson Memorial, in Stafford Springs (1.27); Charlotte Hungerford, in Torrington (1.19); St. Vincent's, in Bridgeport (1.09); Manchester Memorial (1.04); and Yale-New Haven (1.03). Many Connecticut hospitals have been working on quality improvement programs, but the rates still reflect more work that needs to be done.

January Health Hint:

According to MIT researchers, "the average human sneeze expels a high-velocity cloud that can contaminate a room in minutes." In fact, did you know that when you sneeze germs can travel at 80 miles per hour? Sneezes can spread infectious diseases such as pneumonia, ear infections, strep throat, and cold sores (herpes virus) and the flu. Since viruses suspended in sneeze droplets can be inhaled by others or deposited on surfaces and later picked up as people touch them, sneezing is a very powerful form of transmission. So one of the best ways to protect yourself from the germs all around you is to WASH YOUR HANDS.

Factoid: In an observational survey in five cities, 77% of people washed their hands after using the public rest room. Men washed their hands 66% of the time. Women were cleaner, washing their hands 88% of the time.

Children young enough to sleep in cribs

are being given antipsychotics.

In a NY Times article, the author relates a story of an

18-month-old child on epilepsy medication being given an antipsychotic to counter violent behavior believed to be side effects from that medication. When he began to show other unusual behavior, the
mom researched the medication, Risperdal, that he had been given. She found that it was not approved nor had never even been studied, in children anywhere near as young as her child. The article goes on to point out that "almost 20,000 prescriptions for risperidone (commonly known as Risperdal), quetiapine (Seroquel) and other antipsychotic medications were written in 2014 for children 2 and younger, a 50 percent jump from 13,000 just one year before, according to the prescription data company IMS Health". Studies suggest that as many as 10,000 children in this age range are being prescribed antipsychotics. According to Dr Gleason from Tulane University School of Medicine, "children with ages measured in months had brains whose neurological inner workings were developing too rapidly, and in still unknown ways, to risk using medications that can profoundly influence that growth. She said the medications had never been subject to formal clinical trials in infants and toddlers largely because of those dangers." Our concern, at CTCPS, is that there is a lack of studies to determine the potential problems, contraindications and downright potential dangers inherent in giving these medications to young children. We suggest that parents ask questions of their pediatricians and do as much of their own research as possible when it seems that these medications may be needed.

What are Patient Advisory Councils?

Typical Description of a hospital PFAC

There is a new kind of patient volunteer at many hospitals. They are community members, often people who have been patients, who are asked to participate on a hospital's Patient and Family Advisory Council (PFAC). These volunteers are not found in the more traditional roles that we have become accustomed to seeing former patients in, at the reception desk or assisting people getting from one place to another. They are participating on committees that provide patient input into hospital matters ranging from food service to how patients are treated upon check-in to visiting hours to hospital design issues.

There are financial motivators that are partly responsible for the hospitals' strategy to increase their patient engagement in this way. The government has linked Medicare reimbursements to patient satisfaction scores called HCAHPS. In addition, as patients are paying a greater share of their hospital charges due to changes in insurance coverage, their expectations are increasing and hospitals are more interested in knowing what matters to them. According to a recently published study in BMJ Safety and Quality, 38% of hospitals surveyed had these councils. Some hospitals have one council, while others have multiple councils for different purposes. Historically, patients have not had a meaningful role in hospital policy discussions, yet without patients, hospitals would not be in business. Patients are the most underutilized resource in healthcare and PFAC's are beginning to appreciate the value of patient input. If you are interested in participating on a council at your local hospital, give the patient engagement office a call or speak to a nurse or other person at the hospital who you might know. If you are interested in learning more about this, read Hospitals Form Patient Advisory Councils to Learn How They Can Improve Care in the Wall Street Journal.